Barriers to Entry

The term barriers to entry entered the lexicon some years back, and most often it's used in a business sense. People refer to industries in which companies need a lot of capital to get started as having a high barrier to entry. The same can be said of professions, such as law or medicine, that require a rigorous advanced degree. But as parents of a child in the NICU, the barriers to entry that Stephanie and I face every day are physical not metaphorical. Let me explain. When we arrive at the unit, we come to a locked security door. We can see through a window into the unit, but we can't get inside until we press a button and get buzzed in. Often the receptionist is away from her desk, meaning there's no one around to let us in. So we wait until the receptionist returns, or until a nurse or doctor walks by, presumes that we're parents eager to see our baby and swipes his or her ID to unlock the door.

Once inside the NICU, we encounter more barriers. We hang up our coats, stash our shoulder bags in a locker and begin the process of scrubbing up. We wash our hands, scrape the dirt out from under our nails, dry our hands and apply disinfectant. Then we pull on a gown, often struggling to squeeze our arms through the narrow ribbed cuffs. And then, finally, we go into Room 2, where Eli has resided since he was born nearly four weeks ago. There we encounter more barriers: a nurse who may be busy administering to him, the plexiglass walls of his incubator, or Isolette, as it's called, and, finally, after we reach in through the portholes to touch him or change his diaper, the tangle of wires and tubes to which Eli is tethered.

Mind you, I'm not complaining about any of this—the nurses, as Steph has said, are angels, and the state-of-the-art medicine is a godsend. I'm just trying to describe what we go through. Today, however, with the help of Liberty, a wonderful nurse, and Nori, the nurse supervisor, we were able to penetrate every last one of these barriers: Stephanie got to hold Eli against her bare chest for the first time, mother to child, skin to skin. The nurses wrapped a blanket around Eli and Stephanie to form a kind of pouch. This is called kangaroo care, and studies suggest that it offers great benefits to both child and parent. Judging from the expressions on Eli's and Stephanie's faces today—pure, unbridled love—I have no doubt that's the case.

Liberty!

Eli was liberated today—Finally I was able to hold him! A common expression in the NICU is "he's the boss"; well, his now favorite nurse, aptly named Liberty, decided that he was showing signs that he was ready. It was an incredible moment, one that words fail to describe. For almost four weeks, we had waited to hold our little boy and the wait, at times, was excruciating. We had watched other parents holding their babies while ours remained behind plexiglass. Our turn has finally arrived and we are overjoyed. Daddy is next!

Special Teams

One of the funniest "opera fan" moments I've had was when I walked out of the stage door after a performance of Siegfried. In that opera, like all of the other members of The Ring Cycle, I play only sporadically. Consequently, I get to shuttle in and out of the pit quite frequently; I come in, play about four notes, and then leave for upward of 45 minutes at times. It's a nice job if you can get it. On that particular night, I was rushing to get home when I encountered a breathless very enthusiastic man (obviously a sports fan too) who said "Hey, you're the piccolo player, right? You're like special teams!" The confused look on my face must have betrayed my ignorance of the finer points of football so he went on to explain, "You know, you come in, kick a field goal and leave!" A more apt description of my job I had never heard. I have used the analogy ever since.

I believe Eli is also practicing for a career in special teams. He absolutely loves to kick (see the photos in the previous post as well); he can hardly stay still. I'm a bit worried as to what this means for when he comes home! :-)

First Outfit—the Results Are In!

Another up and down day, this time, for a different reason. I asked the head nurse, Nori, if I could hold Eli today. First she said yes. Then she said no. Then she said yes. Then she said no. You get the picture. After watching his oxygen saturation go up and down several times, she finally decided that Eli is just too unstable; she didn't want to risk taking him out of his isolette. She did kindly offer us a compromise and agreed to open up one side of the isolette so we could kind of cradle him in our hands. First, she asked that we dress him in this hat and booties to keep him warm. I don't think he minded that they were pink (those of you who voted for pink as his first outfit on the blog poll were right!! :-) and neither did we because he looked ridiculously cute. I think he enjoyed the session as much as we did. We stayed like this for about an hour and a half and he seemed to have fewer desats while we were holding him. He was wide awake for most of the time too. It was really something. Nori said we can check again on Friday about the prospects of holding him.

By the way, did you happen to notice that quickly sprouting head of hair in the first photo? I think we might have another blondie in the family!

A Better Day

Eli was much better today. Though he did have a few desats while we were there, it was nothing like yesterday. We spoke with his doctor, Dr. Paley, who very kindly gave us 30 minutes of his time. He showed us an X-ray and pointed out that Eli had some fluid in his lungs. Dr. Paley said that he had started Eli on a diuretic to help clear that up. He also noted that Eli had his fourth, and final, head ultrasound today which he passed with flying colors.

We also asked Dr. Paley when we might be allowed to hold Eli. This being three weeks to the day since his birth, it is getting tedious to only be able to touch him through the isolette portholes. Dr. Paley said he would speak with the charge nurse so we are very hopeful that soon it will come to pass. :-)

Roller Coaster

Eli gave us a little scare yesterday. He was "desatting" all day (that's when the percentage of oxygen in his blood drops) and he had at least two bradycardias (when his heart rate drops sharply). His doctors and nurses tell us the bradies are usually caused by Eli forgetting to breathe; they say it's a normal symptom of prematurity. The nurses all remain so calm, but as a parent that's hard to do when the alarms are going off, literally, left and right. Also, through reading, we've learned that bradies and desats can also be a symptom of infection or other respiratory problems. So that doesn't help with our level of calm.

Back home after having spent the stressful day in the NICU, I decided, at about 9:30 p.m., to call in to check on Eli (the unit encourages parents to do this). Eli's nurse for the night, Julie, told me his condition remained the same and that she'd just alerted the attending doctor, who was considering at that very moment whether to do a complete blood count (CBC). While I was on the phone, the doctor decided to go ahead with the test even though one was ordered for the morning. Julie told me if I called back at 11 p.m. she would have the results. When 11 rolled around, I called, but Julie was busy doing an X-ray (on our Eli, it turned out). She finally called me back at 11:30 to say that the CBC had come back normal, indicating Eli had a good red blood cell count and no infection. They were just waiting for the X-ray results. More breath holding, but, fortunately, this time only for 15 minutes; I called back and learned the X-ray was normal! Finally I could sleep soundly.

They told us there would be days like this—"It's a roller coaster," we keep hearing—but it's hard to imagine when Eli is sailing through day after day with no major problems. Yesterday is not what you'd call a "setback," but it sure was stressful. He's still very small, and we just have to keep in mind that most of these kinds of things are normal parts of development. After all, he was supposed to be immersed in amniotic fluid at this point, not having to breathe on his own or really do anything except grow.

Nurse of the Year

Another good day for the little guy. He's not as little anymore, having gained 30 grams yesterday!! (That's over 3.5% of his previous body weight) He's now 845 grams. Also, he came down again on his ventilator settings and, so far, is tolerating it. He is up to 13 cc's on his feedings.

Evelyn, his nurse for the past two days is really great. We will miss her. The nurses all rotate so we rarely have the same one for more than two days. We hope to get Evelyn back soon. She was definitely one of the best we've had; though all of the nurses are amazing at their jobs, they all have different personalities. Evelyn is very warm, explains everything in a non-condescending way and clearly loves her little patients. She even gave me a hug before she left for the weekend!